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In people with a herniated disc in the lower back, low-quality evidence suggests surgery may reduce pain and improve function in the short term

Chen BL, Guo JB, Zhang HW, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil. 2017 Jul 1:269215517719952.

Review questions

In people with a herniated disc in the lower back (lumbar spine), is surgery better than nonsurgical treatment for reducing pain? Is it safe?

Background

Herniated discs are sometimes called slipped or ruptured discs. They can cause leg pain, numbness or tingling, or muscle weakness. Many people with a herniated disc will have no symptoms. For people who do have symptoms, improvement over time is common.

Treatments for herniated discs include drugs (e.g., pain relievers, muscle relaxants, steroids), physical therapy, spinal manipulation, acupuncture, and surgery. Nonsurgical treatment relieves pain in most people with a herniated disc.

How the review was done

The researchers did a systematic review of studies available up to May 2017. They found 19 randomized controlled trials with 2272 people who had an average age of 36 to 66 years. Most trials were done in China.

The key features of the studies were:

  • people were older than 18 years of age and had a herniated disc in the lower back;
  • surgery was compared with nonsurgical treatments;
  • surgery mainly included discectomy (removal of part or all of the herniated disc), laminectomy or disc decompression (removal of part of the vertebrae to enlarge the spinal canal and relieve pressure on nerves), or minimally invasive surgery;
  • nonsurgical treatments mainly included physical therapy, spinal manipulation, acupuncture, drug therapy (e.g., anti-inflammatory drugs, muscle relaxants, steroids), and bed rest; and
  • people were followed up for 1 to 3 months (short term), 3 to 6 months (mid term), or 12 months (long term).

All studies were considered to be low quality, which means the results may not be accurate.

What the researchers found

Compared with nonsurgical treatments, surgery:

  • reduced pain assessed using some measures but not others;
  • reduced disability assessed using some measures but not others;
  • improved some quality of life measures (bodily pain and physical function) in the short term;
  • did not improve other measures of quality of life; and
  • did not increase adverse events.

Conclusions

In people with a herniated disc in the lower back, surgery may reduce pain and improve function compared with nonsurgical treatments. However, the quality of the evidence is low, which means further research is needed to confirm that the benefits of surgery outweigh the risks.

Surgery vs nonsurgical treatment for a herniated disk in the lower back

Outcomes*

Number of trials (people)

Absolute effects of surgery

Pain

16 trials (1585 people)

Decreased pain scores on some measures but not on others.

Disability

7 trials (1160 people)

Decreased disability scores on some measures but not on others.

Quality of life

4 trials (970 people)

Reduced bodily pain and improved physical function in the short term.

No difference between surgery and nonsurgical treatments for other measures of quality of life (general health, mental health, vitality, social function, and limitations due to physical or emotional health).

Adverse events

6 trials (1060 people)

No difference between surgery and nonsurgical treatments.

*Scales used to measure pain: visual analogue scales, numeric rating scales, and the Japanese Orthopedic Association scale. Scales used to measure disability: Oswestry Disability Index and Roland Disability Questionnaire. Scale used to measure quality of life: 36-item Short-Form Health Survey.



Related Topics


Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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